| Prosthetic training each 15 minutes CPT 97761 • Physical Therapy | $26 | $33 | $37 |
| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $23 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $9 | $9 | $9 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $11 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $371 | $371 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $260 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $104 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $25 | $25 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $101 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $56 | $56 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $143 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $95 | $140 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $136 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $69 | $83 | $97 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $49 | $80 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $52 | $84 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $83 | $101 | $119 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $58 | $58 | $58 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $94 | $121 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $102 | $102 | $102 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $42 | $42 | $42 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $66 | $90 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $46 | $74 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $52 | $82 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $73 | $73 | $73 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $78 | $100 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $84 | $113 | $137 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $25 | $31 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $58 | $120 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $214 | $276 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $214 | $214 | $214 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $82 | $125 | $169 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $104 | $155 | $198 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $82 | $112 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $157 | $198 | $238 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $172 | $172 | $172 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $95 | $160 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $63 | $96 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $102 | $233 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $778 | $1,028 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $57 | $82 | $108 |
| Spirometry CPT 94010 • Pulmonology | $5 | $18 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $6 | $18 | $30 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $17 | $41 | $66 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $25 | $27 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $97 | $138 | $178 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $5 | $5 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $11 | $24 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $28 | $40 | $51 |